Provider Demographics
NPI:1528847399
Name:SMITH, CAROLINE C (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PARKER HENDERSON RD LOT 252
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-6295
Mailing Address - Country:US
Mailing Address - Phone:214-769-1880
Mailing Address - Fax:
Practice Address - Street 1:5400 PARKER HENDERSON RD LOT 252
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-6295
Practice Address - Country:US
Practice Address - Phone:214-769-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXZ5A9E2T5246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty